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Dr. Marty Makary Education. (2012) 'Unaccountable What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care.'

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Us 8, U.s. 5, Ken Ackerman 2, United States 2, Tommy 1, Everson O'hanlon 1, Flabbergasted 1, Don Burke 1, Booktv 1, David Bates 1, Incentivize 1, Wayne Karlin 1, Housecall 1, Pop 1, Perl Program 1, Hopkins 1, United 1, Goodyear 1, United States Nec 1, Dr. Marty Makary 1,
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  CSPAN    Book TV After Words    Dr. Marty Makary  Education.  (2012) 'Unaccountable  
   What Hospitals Won't Tell You and How Transparency Can...  

    December 16, 2012
    12:00 - 1:00pm EST  

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so we traveled with the family to the killing grounds, that to them on young mountains and so on. to make it short, we found the grave. when they disinter the body, they found several objects that for them nailed it that this was dam. they basically cleaned the bones, put them in a small box. they were traveling by car and train. we went back up north and had a funeral. and if there's hundreds of people when i brought the notebooks back, now there are thousands. they had the funeral ceremony and homer became of the casket bearers. so i have this image of him. the other casket bearers are all vietnamese army soldiers, wearing white dam would've worn.
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it's not a costume. that's the uniform. and he is carrying the weight of the guy he killed -- excuse me. we had a procession about it: under out to the graveyard and we buried him. my sensei doing all that was with trauma, you. the bad staff. and in order to heal from that time you have to dig it up and commemorate it and put it back in the earth. we have literally done that. for the sake they were carrying the war. >> wayne karlin teaches language and literature at the college of southern maryland.
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he's a southern novelists. this is a nonfiction book. "wandering souls: journeys with the dead and the living in viet nam". professor trained to karlin, thank you for joining us. >> coming up, booktv presents "after words" orientate gases to interview others. this week, dr. marty makary examines dangers of a hospital stay in his book, "unaccountable." the john hopkins surgeon provides an inside look at
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hospital errors, overtreatment in the closed-door culture that protects medical practitioners. discuss the findings and experience with president of washington d.c.'s sibley hospital, richard davis. >> hi, i'm cheap davis and i'm here today with marty makary, author of "unaccountable: what hospitals won't tell you and how transparency can revolutionize health care." so welcome. >> guest: good to be with you. >> host: you are an expert in this field. tell us about the reasons that you decided to write the book and some of your findings. >> guest: well, two main drivers led me to write the book. number one, patients often tell me when they come to the hospital they feel like they're walking in blind. there's a strike system they don't know how to evaluate. when he asked my patients, why did you choose this hospital,
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over my career i've gotten answers like the perky near as good. we can do better than that. this is one fifth of the u.s. economy and competition seems to be at the wrong level impatiens are frustrated. the other reason i wrote the book is doctors are getting crushed right now. they've got declining medicare payments come increasing overhead. hospitals have more expenses. malpractice rates are going up. the burnout rate in health care is 40%. doctors are getting crushed right now and i felt like we need to voice out there and it's okay to talk to the general public. >> host: so you make the point that medical mistakes if you alert the third leading cause of death in the united states. that is a shocking figure. can you talk about? >> guest: it was shocking for me if somebody interested in this field of quality to see you put in that way. medical mistakes are number three. we kill as many people from
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medical mistakes as we do from car accidents and other causes of death in the u.s. i never thought of it that way because we don't talk as openly and honestly about mistakes as we showed in our profession to be very blunt. you think about number one, heart disease. number one cause of death in the u.s. we spent a lot of time and energy on her prevention of heart disease. cancer, a ton of money going to cancer. medical mistakes were just now beginning to recognize this is number three and some people have told me after i wrote "unaccountable," there's not a medical mistake problem in the u.s. and i think we're starting to just now except this is something we've got to start talking honestly about. >> host: so we know there's tremendous care that he's received here in the u.s., certainly at the institutions to
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train to. at this confab of kind of quality and disparity of quality and you got interested in it during your talk perl program at harvard. can you talk about how you came into bottom what's your interest was awarded the field come from? >> guest: pitches started to be recognized as a field that i was a student. i had this frustrating experience as a patient of mine that i was assigned to follow. her name is mrs. banks and she's in the opening of the book. she didn't want anything done for her cancer, which had spread all over. the doctors clearly wanted to do something. they essentially bullied her or talked her into it. they overstated the benefits and under siege at the risk, something we know from research happens, especially those of us
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who do procedures it just didn't seem right to me. it seemed as if profession wasn't telling the truth. he seemed medicine have long straight from its original mission and heritage. it's not why it went into medicine and i quite frankly quick. i started school where i met david-based evolution money. >> host: i'm sorry to interrupt. you are an medical school and you had enough and the two school public health? >> guest: i explained it at the morning conference. it turned me upside down for exciting to them she didn't want the procedure done. they basically implied it didn't matter what she wants. this is what she needed. this was to me definable culture that i observed from the outside but didn't want to be a part of. adequate medical school.
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and then i started graduate school for public health because i heard of a track where you can focus on quality and they were people not interested in medical mistakes for the first time they were describing studies where they were lucky not handwriting and it was a radical concept of the time. david bates but a study or describes the head of one of the largest organizations in the states calling him. and basically saying what are you doing this for? this is not a problem. you realize we've had these explosions of knowledge in medicine, but we have not coordinated care and all the services we have ended up having so many cracks but the cracks are as harmful as the diseases we are treating. you've got to step back and ask, you know, are we hurting people overall?
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on the global level, but we do and sometimes now we've got these reports saying 30% of everything we do may not be necessary. the tests we order, procedures. this is something for the first time really being called out as a problem. people out there in the general public have been saying for a long time, we don't like the closed-door culture of medicine. refinement is said to be an arrogant industry. we feel like we don't connect. i remember in medical school being told in no sleep with at is. is it not a nosebleed? it's like a whole different vocabulary and that disconnect has created an issue with our trust in the public in this issue of overtreatment has further strained the public
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trust that medicine is bad. it's a great job, a great profession. you're in health care and everyday you see see folks have tremendous result was the byproduct of phenomenal advances in technology and the art of medicine with compassion. it is a great profession. when we've got better since they 30% of the time we missed the mark we've got to study this. would that make it a discipline of science and say how cool you look at this likely look at can how could we streamline care. i was the main reason i decided to write "unaccountable." >> host: that statistic of 30%, problems with quality, waste, variability is a stunning statistic. why do you think that -- you mentioned culture a while ago. what is it about the culture of health care, where those types
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of duties have been allowed to go on for some chilling the time? if elected any other industry, a 30% waste or 30% error rate really would be unacceptable. how does that occur within health care? >> guest: you know, it's a great wonder why people tolerate 30% waste in health care, but they wouldn't tolerate it in any other industry. aside a statistic recently. the average income of an american and united species, 30% over the last decade. the increase in health care costs they pay has gone up about 60% over the same time. essentially we've offset increases in income with help care costs. so you wonder why you said we tolerate this? attempt to business leaders say, every contract or we pay we have some magical power will be
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performed except for one, health care. we keep throwing money at it. patients say the same thing with premiums and high deductibles. what more medicating quakes what are we are we getting for her there's been this culture of medicine that has respected the art of individual autonomy. but it's a great risk for some best practices never get standardized. in my own field, pancreas other transplant, we take a pancreas that if somebody, treat the cells into the cells it to the patient. when is a laboratory to treat the cells. well, that occur at 11-point paid a bonus $20,000 payment to hospitals for doing this on top of what they were already charging. it became a very profitable business. we have a laboratory at johns hopkins in the operating room and the patient asleep under anesthesia, take a pancreas,
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treat the cells come and get the cells decorate them and there come the same operation. hospitals started doing this operation, taking the pancreas. because they don't have the laboratory, put it in the cooler and send it to another city, how they treated at another facility in another city or state. how the phone back and cut the patient open again for a second operation. why would anyone have that procedure done? they don't know about the other option. i'm not talking tiny hospitals. i'm talking to a news world report and the countries do this. we've got smart people, good people working in a bad system, where financial incentives lure people to do things that just aren't ready. if hospitals are accountable for the results, if the patient satisfaction scores, outcomes, complication rates, volumes i readmission rates, on the basic metrics of health care reform
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and the doctors and nurses that would, if they were available to the public, people could choose where to go based on who performs the best like any other free-market works unlike any other free-market uses in their field. >> host: the issue of patient choice about where they seek care is one that's been out there and certainly in literature and discussions amongst leaders for a number of years, where many people advocate that if indeed patients have the opportunity to see the quality coming to see individual performance, hospital infection rates, that they would naturally gravitate to those institutions. there's another school of thought that says you can put the information out there, but that won't really happen. patients will gravitate to. you referenced in your book were patients seek their care. i go there because my mother was
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born there or because it's two miles from my house. talk to me about the balance there anything you quality is a fact there. how do we get patients informed as to how they can seek to set her nation and really will it make a difference where they seek care? >> guest: i've got some patients the tummy talk, whatever he wanted to, tommy and onto it and they've got total blind trust in the system. maybe for then that's okay, but more and more patients want to know the options. they want to know something can be done minimally invasive. if there's a holistic preventive they want to know now. increasingly we see that. one critic of the book told me if you put stuff out there, people will never use it in a won't reduce health care waste.
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well, for weeks after the book came out, a study in the journal of the american medical association showed that when there is public porting of harpies teachers, students and angiograms, the overall number of procedures went down by 14% and there was no difference in patient outcomes. big study about four weeks after the book came out showing that public reporting reduces waste and has no impact. patients do just as well. so increasingly, we are learning that the impact of public reporting. all of us know doctors who should not be practicing. when national conference i was at, how many of you know that that tradition be practicing because they're too dangerous? everson o'hanlon. and because we all recognize there's going to be some bad apples that will really respond
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to financial incentives and that there's little accountability in general in health care hospital seven miles down the street from my hospital had a.to put in at least 500 unnecessary hurt since. now if those procedures would've been recorded in giving to the patient on a thumb drive as the advocate in the book, "unaccountable." he wouldn't have gotten way with giving students an arteries that were bought. it would've been over say like when we are speed traps with humorous at an intersection, everybody follows the law. the compliance rate is a want of run to follow the speed limit for decades has been hard to do since we've had automobiles even trying to do education. education doesn't work. what works is when someone sees a camera or officer of the site of the road.
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then everybody is compliant and i think we in health care have a lot of room to increase accountability and quite frankly, it will really restore the trust that's been broken with the general public. >> host: so let's go back to the culture question. i was riveted by your account to when you're with that room and everybody raised their hand that in fact as you describe it come you were hesitant to pursue research and was a senior position next year will look at humans have really come you don't know anyone and they need to. what about the culture of medicine do you think has led us to this point of where we actually know that harm may be occurring or have a sensor that the we've gotten to this point where people are afraid to speak up, afraid to criticize their peers or the institution. you make a point a number of times in the book and then actually your opening chapter,
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where you talk about the fact that go to are the people in health care, the nurses and doctors in the restrictors of that hospital, where they would seek to care. how does the closer if you will proliferate what you've been talking about and for the public, how did they seek that information out? >> guest: i once told a friend and i say to find out about the quality of a hospital is to ask an er nurse who works there. a nurse knows more about the quality of a hospital than probably anyone else. for that matter, in any industry, front-line worker providing services could be if sales are creating products probably knows more than any administrators about the culture. the reason is culture trace everything we do. in economics, there's a space no one has ever washed a rental car because they don't own it.
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defensive tone in the delivery of care is of critical importance in health care. that's what bothers me about seeing the statistics found that 46% of doctors in the united states are earned out according to the mayo clinic. i did a study three weeks ago. what we've got 46% of front-line providers in any industry burned-out, of course the quality will be variable. of course people will fall through the cracks. when people don't feel like they own service. docs tell me when i go to conferences and speak, i have to know how to make health care better at my institution. i know how to make the care safer for patients. i just don't feel anyone listens to me. i don't feel empowered and that is one of the great divide right now in health care in the united states. increasingly, we have some doctors saying that some
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facilities that there's a chasm between themselves and their unit manager, between themselves and those making the policies are those calling the shots on a national level. they don't feel empowered and i think we're seeing more variability because of that. >> host: you talking about providing administrative crackdowns administrative crackdowns if you will, where you could providers of care and senior administrative leaders working a little bit work together or getting the administrators out from their offices if you will. talk about that and what you see the value of their while i think impact on the quality and safety. >> guest: we all want the same thing. doctors, administrators, insurance companies, policymakers. as an astronaut from outer space who is fast, what does the middle east look like from outer space? in the astronaut said there are
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no lines when you look at it. the lines have been made. and that's what's going on in health care. the lines we've made in health care or man-made. we'll want the same good for the public. we've got good people. they're just sometimes working in this artificial system. we told administrators can make a profit, so your bed yesterday make a profit until their bed. we told doctors to see my patients to the tumor. we tell doctors do more procedures in the duma procedures. everyone is doing their job, but as don burke said, it's like the jobs are designed wrong. when my dad was practicing doctor or decreasing her hospital, i remember this administrator named ken ackerman who would come down and sit down with the.there's eared he would walk down the hallway, pop himself right in their office and say how's it going? would you need to do your job
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better? he was in a doctor ken ackerman, but the doctors on this staff said he was the administrator in a white coat. that's how they came to make make him. he was in touch with front-line providers. you use the amount kinds of industries, via lehman brothers, be it a large corporation delivering a service that's multinational. when the administrators is touch with front-line folks, that is impacting starts happening. that's in the accountability becomes a problem because there's no transparency and that was the impetus for writing "unaccountable." >> host: at a hospital president, i'm always struck by the fact that if you want to know where the issues are as you describe, you go to the front-line. go to the operating nurses. but why do you think in many
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hospitals, perhaps to become a separate differentiation or divide if you will between administrations about and does it have anything to do with incentives? you talked earlier about misaligned incentives if you will. so what do you think? >> guest: i've seen both extremes in the united states and talked about both extremes of the book. i recently learned of an emergency room of his coat is freestanding with the hospital attached to. can you imagine if a heart attack in the emergency room and they don't have a house of achieving. they have to ship it across the floating bridge to another hospital because that's versus hospital. this happens in the united states nec's doctors say this is afraid. even administrators say we know
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it's not rational, but that's the way we get paid. they get paid more for emergency visits and private care. when things are disassociated, the care gets dangerous and many see times there in harmony. you see when there's transparency of infection data, how the administrators talk to individual providers specifically about infections. what do we need to do to get infections down? this is a model of management for any industry. the near transparency experiment underwent heart surgery outcomes are publicly reported, i tell a story that mark chesson described, are they headed ministers walk into the units and ask doctors and nurses, what do we need to do to get mortality down? they ask nurses bias the complication rate high on how to we decrease it? you don't see that level, mission about reducing
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complications except when everything is aligned, transparency and the data, accountability at all levels for performance and people on the system. i remember hearing the story of a nursemaid we've never seen the ceo here and the cardiac icu except when we public reporting of heart surgery outcomes. you realize these old-fashioned concepts here. these are american concepts. transparency is an american value. we expected that the white house. mix it to the congress. we expect it of wall street. sarbanes-oxley will have a ceo could joke they misrepresent their earnings for the company. health care is a compelling. it's like you can misreport infections but there's not that level of transparency and we treated differently. we have to treat health care like any other business to
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reduce the ways cost for everyday americans. people are getting crushed right now with deductibles. they are essentially paying for all of their health care with the exception of catastrophic care. it's becoming a two-tiered system. we see primary care doctors say just pay us a couple thousand dollars a year from a work to take of you. but with housecall is to have my cell phone. it's medicine the way they practically, the way we dreamed of practicing medicine. it's health care to the only streamed restrictive getting it and they're rejecting, revolting against his bureaucratic regulatory system that involves fighting with insurance companies and other hassell's doctors could crash at right now. >> host: this talk about leadership in the world leadership plays. i loved the story you tell about roper v.
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i use that story myself. talk about the rule and the example of that story in which think it means to senior leaders in health care. >> guest: jeanneau, i say many times somebody everybody wants the same thing but there's a break down of communication. when bill birdie walked through the icu. host hotel who build rodeos. >> guest: he's president at this initiative to get executives adopt a unit to many executives at hopkins adopted a unit, an acu -- icu and he put the stats and we still do a similar safety concerns here? how are you going to harm the next patient? anticipate was going to go wrong next time i have a medical
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catastrophe. every year at every hospital in the country, doesn't matter the best or worst has medical mishaps every year. these discussions create an anticipation that allows people to redesign and reengineer the hospital system to make it safer. the employees, staff and nurses will value. the few people listen to them. i went with a 46 of doctors saying they burned out, don't feel valued, getting crushed all part is insurance premiums and had an affair with insurance come means, it goes a long way and not feeling value despite her hospital or leaders is a serious way to alienate the very people that are responsible for safety and creating a safe culture. >> host: for those of us who are leaders or ceos of hospitals, et cetera, what role should accountability and
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transparency play in the way we conduct our daily business? was your perception on that and where can we improve? >> guest: it seems like it the old guard of the establishment or a few corporation to resist a little transparent tea. when you type the individuals, the people, the moms, the parents, those who take care of patients, doctors, people who are administrators. they are pushing us and we see this transparency revolution not driven by patients ironically, they triggered by the doctors and administrators and organizations to see the waste in health care. it bothers the heck out of them and they want to do something about it. we see thoracic surgeons,
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organizations, leapfrog, all these organizations rallied together to say we think it's the right thing to do to be transparent about what we do. we are proud of her results. we've got nothing to hide. if we perform well, the public should see it and if we don't, the public should see it anyway because were honest and transparent. i once ordered a cat scan on a patient. it cut down on the wrong patient. this in the senate about this richard patient's bedside that i'm sorry you didn't picture cat scan because there is a mistake. i'll make sure you get it done right away. to the other patient i said, were sorry you got a cat scan. it was intended for someone else. it was a mistake. sorry, all saw the results with you if you want to see them. the patients were not angry that i thought they would be. they looked at me with a sense of appreciation. thank you for being honest with me, don't her. i feel he patients a lot of
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times just want honesty. they want to be treated with dignity. they want to be treated like they would in any other business. that's what people are hungry for in health care and that's what the organizations and leaders in health care are saying we need to provide the patient. we did a research study recently that looked at the number of national databases that follow hospital performance and patient outcomes. by the pancreas transplantation, their databases we report outcomes too. there's a national pancreas transplant registry. they follow the outcomes at different hospitals that do this. the public has no access to this information. in our research study we found there's over 200 national hospital outcomes. only three make their data available to the public. most are funded by taxpayer dollars in some form. i think we as a society are starting to ask the question, do
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we have a right to know about the quality of our hospitals? i think we see theaters in health care step up and say yes we do. >> host: you've raised provocative and compelling issues here and your book really has a think ben truly illustrative to people in terms of some of the things going on. and makes "the new york times" bestsellers list, et cetera. i'm interested to know the comments of your peers in this, both younger physicians, older physicians. use the term old guard a couple times. he put this out to, talk about this. many people are recognizing the. talk a little bit about what impact did that and really how people feel of the feet tactic
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again. >> guest: i've gotten thousands of letters, many of which are handwritten. tens of thousands of e-mails that say my mom died because of a medical mistake. we didn't feel it we were a part of the process. we didn't feel we were given all of our options. we feel there was a mistake or know there was a mistake. thank you for sharing this story. it's almost as if everybody has the story. at that personal accounts here of people i know that had suffered from medical mistakes. everybody had the story. it's the number three cause of death is medical mistake. i think there's this general appreciation for talking about this openly and honestly. the younger.yours in particular come from a different generation. medical students nowadays have very little tolerance for not telling the church in any aspect of life.
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they insist on transparency in all aspects of their living. and then there are what are referred to as the old guard, some salmon expert in medical mistakes. we should be talking about this at the general public or there was one individual whose response to the book said there is a typo on the inside of the jacket of the cover. 30% of health care is unnecessary and the responses there's a typo? medical mistakes are the number three cause of death. of course there's different responses. health care is a very emotional issue. look at the way the politicians have divided the country and polarized the subject into sound bites. health care is complex. the reality is there are good ideas on both sides of the aisle and we just need to talk about
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common sense solution in health care. all the different ideas we hear about from politicians are centered on how to pay for health care differently, how to fund the broken system. we don't have to talk now how to finance a broken system. we've had to move on how to fix a broken system. i think that is a fundamental discussion, which gets to the basic transparency, patient outcomes, patient choices and patient empowerment. i've lived in d.c. for a while and i know politicians are not going to fix health care permanently. we doctors are going to do it. insurance companies are going to do it. it's going to be the patients and they've got to give them good information. a 60% of new yorkers are looking up at a restaurant track ratings before they go there, why do you have to walk in for their health care blind about what a hospital c-section rate is or infection
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rate or how many hip operations we do or how many knee operations they do. if you have lyme disease can i do want to go to a hospital is the only case in five years they've seen or do you put a hospital that treats 50 cases a year. these are basic things the public demand in any other industry and we can provide these things in health care tumor transparency. >> host: so that leads me to -- use the term flood friends don't care in your book. talk about that are your thoughts on how that plays into what you just described, which is 60% of new yorkers who go online and look at the restaurant review, but to just walk right down the street to their hospital without doing any due diligence, et cetera. how is the fred flintstone care
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in the culture of medicine play into that? >> guest: i am constantly flabbergasted at how patients walk into a doctor's office and the doctor will not mention the superior option to the patient. i think sometimes because they're worried about losing the patient to another doctor. you pay a lot of money based on the quantity of what we do. that's got to change. we've got to be paid based on the quality and outcomes. we've got to get away from this heavy volume oriented way we finance our health care system. we are incentivizing people to overture. are we as doctors in the survey, weise's overtreatment of the epidemic so broad? they say because were so heavily incentivize. usually they don't say themselves. there's malpractice concerns and other things that have the answers. but a lot of the doctors to have
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the answers on how to address this problem of medical mistakes in overtreatment. i talked to dr. psalmist every week if sandy text messages and e-mails from my superiors to give our operations and if you like and doing the right thing for my patient. they don't like that. that's not the type of medicine or profession they wanted to. i think we need to start thinking about how patients can get the best options by eliminating these heavy incentives to under refer. there are patients that i've met, rotating us a resident there were not told there's a superior way to reconstruct the after removal because the local plastic surgeons don't do it that way. they do it another way. the research and literature clearly shows inferior. it's silly standard of care. they won't get sued for doing
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it, but there's wide variations. my own field of pancreas surgery, if you have a small pancreas cyst that needs to be removed in the tale of the tanker is, a patient walks into one hospital, they'll have a big mainline station. but the tale of the pancreas removed in their spleen. walk into another stop to stop the symbol of a small, minimally invasive keyhole incision cannot remove the spleen. talking about removing or not removing the organ based on what store you walk into. all good hospitals, good reputations cut radically different ways of doing things. removing it:. there's two totally different ways of doing it. minimally invasive and threw it open incision. some say you can do it either way. we have the "new england journal of medicine" over 10 years old
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that shows minimally invasive is better and it's common sense is better. if the wild west of medicine would have it that only patients that are great candidates will ever have it done that way. >> host: use the term the wild west of medicine. that's where in your book you talk about the need to have a new sheriff in town. so top name a bit about this concept of the new sheriff in town or accountability are holding people responsible in how that balances with what we frequently hear what we train before the standardization or accountability to the art form of medicine. how did those two things kind of play out? >> guest: i get the art form of medicine. most of the patients that come to seamier complicated pancreas tumors. this is my own area of expertise. justin mayfield they see these
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complex cases where patients are told there's nothing that can be done at the other hospitals in the come to me we say yes it's high risk. these are the risks if you want to go for it we will go that or survey for a long time for a long time disabling a minute, we can't make outcomes transparent. it doesn't appropriately adjust for the high-risk nature of cases we take on here. i agree 100%. as a matter of fact, doctors are right to lead the opposition to transparency. if we make the raw data transparent, we could punish thought there's a take on the noble high-risk cases to reward those who discriminate against them. we actually create perverse incentives. but now that yours are saying with a valid ways to measure quality. we've created these measures. we endorse them. we monitor them with their own national registry house by the
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doctors groups. we think it's the right time to make this available to the public and for the first time ever, this is an exciting time in health care and transparency. with that consumer reports now partnering with.or scripts to make a national registry outcomes available in easy to understand ways so patients can look up what the risk-adjusted performance is, the heart surgery center in their community. this is the future of health care. it's an exciting time, a revolution. it's sort of become an observer at the wheel or reporter on a subject. i'm not the leader of the transparency revolution. in fact, we don't have one leader. this is the truth, something we believed in and are as passionate about the subject itself. >> host: you talk about a decade or more ago.it is
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protected that information because it could be misinterpreted if you will. and then there's been this evolution towards transparency partnerships between consumer groups. if that's the case, what impact has that had in terms of our overall levels of quality efficiency and mistakes? this movement has been going on for some time, yet you cite some really challenging cases and to test it's going on. what is your sense of how things move and where's it going in the future? >> that's a great point. we've got burned with transparency. we've had systems that are local and small in the patients haven't known where to get the information. let's face it, unless there is a central site take hospitals safe to score.org run by leapfrog,
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there's no master dashboard, were not informing the public. a lot of times we created so many loopholes that doctors have learned how to game the system and method have been in new york with her surgery program. there were many successes. we saw the first time cbs and doctors focused on a common vision to produce certain complications after surgery the cpus were saying how about a dedicated anesthesiologists who specialized in hard anesthesiology. doctors say yes, that's what we need. there's this tremendous teamwork with transparency, but the system wasn't perfect. for the first time, we seek out or groups better define what is a complication. we are using independent nurses at a hospital to track the outcomes. early versions we asked the
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surgeon, what's your infection rate? of course it would understate our complication rate and was a uniform bias. it is just the nature of assessing your own performance. now there is an exciting opportunity. we've got organizations adopt are signed up for sale that could all be saved but we can populate the information. the affordable care and try to push some of this forward. i believe there's a lot more we need to push forward. we are missions that will be available to the public and for the first time this year people can look up a hospital infection rate on the national medicare hospital stay about hhs.gov. for the first time they can look up hospitals bounce back or reignition rates. these are what got us generally consider to be valid ways to measure quality.
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i think we had to see consumers rally around them. we have to fix them. they're not good, not perfect. we have to revise them and make them more risk-adjusted invalid. quite frankly we need fresh ideas and health care. we've been talking the same stuff for years. >> host: to this native quality and safety health care is a relatively young field. he talked about the need for patients and consumers to get actively involved. in fact, you referenced the fact that doctors can do it. regulators can't do it, politicians can't do it, the patients have to do it. talk more if you will about the role that patients need to house because today i'm struck with the fact that if i google sent it on the internet, acer disease or treatment, i'll get hundreds, perhaps thousands of different
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sites to go to. one thing i keep hearing from patients if they have difficulty navigating. how do they know what the high-quality data that's out there. you referenced a couple, but if were going to his patients and consumers to play and i didn't grow up to move forward and change the system, how do they navigate the? what is their role within the? >> guest: that's a great question. even with all these hospital safety score, husker du compares, patient satisfaction scores. even with new websites being populated with more and more information every year, nothing substitutes for a great conversation between you and the.your i.q. and a nurse and the doctor's office. there's something to be said for the patient but does the research on google, which is 92% accurate.
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we've done the research of john top is. people type in operation, conditioned by medication, what they look at is 92% right on. there's something we said for people who do that, bring that into the doctors office and have a conversation. i often tell people if you're going to have some denature like an operation or start taking a medication every day for the first time in your life or you don't know what you're wrong with you and the doctor can't take it out. get a second opinion. those are times when we have to remember that scott showed 30% of opinion are different from the second opinion. we are human beings. in my own area of expertise, i will run things by a partner or an expert in the country. if someone has seen a different variation or different presentation, it is no
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substitute for good conversations with doctors. doctors are as frustrated with the broken health care system is patients are. when we see ourselves in the same boat, we have a certain appreciation. it's all medical students, treat every patient like your mother or father. i think that's a good guiding principle that was taught to me. >> host: to follow-up on that, throughout the book you talk about the importance of teamwork can you just referenced it now. but i'm struck with the need for teamwork is to move forward and health care reform as well as some of the issues you've identified. stanford u. know talks about the fact we have many moving parts, many players and health care if you will, where we have many
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people who are responsible, but little accountability overall. so how would you see, first of all, two questions. one, what is the role of teamwork and the care we deliver an importance of that and what is the role of the patient within that? how could we move forward with all the different groups, physicians, insurers, regulators, patients should resolve some of these issues? >> guest: you know, everybody seems to recognize teamwork is a critical part of delivering safe and high-quality care, yet we've never measured it for the longest time. it's almost as if in effect jury you know what part of the assembly line this so shoddiest often on unreliable and it hurts the entire process and yet no one looks at to it. there's now a survey that brian
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sexton created that measures quality of teamwork. asks everyday providers, would you go here for your own care? do you feel comfortable speaking up? t. feel you're part of the team or concerns are not being heard? and it turns out these results have been followed and tracked. they're just not available to the public. the government even issues the survey on its website, makes it available for download for hospitals and collects the information, yet there's no accountability around that. that's one simple thing we can do differently. often times when i talk to docs and nurses, they say when the teamwork is goodyear, everybody is happy. when the nurse turnover rate are low, nurses are quitting and getting hired. with a turnover rate is low, they feel they own the care better. it's a better place to work.
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when i had made near miss if you will, i describe in the book a time when i harmed patient of the mistake i made. i described a time when i almost operated on the wrong side in the nurse spoke a bit nuts with it the patient from having the wrong site besieger. today was crazy busy. i was traveling from the icu to do with a quick emergency, came back to the operating room. i team had prepped the patient and they prepped the wrong side. as a minor procedure, but would've had catastrophic catastrophic consequences for me and for the patient. it's one of those things where you release it is a team sport and more and more we hear the nurses say, you know, if we can have more teamwork, less disruptive behavior. we have a study now from the archives of surgery report, 90% of nurses and 40% of doctors
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have witnessed disruptive behavior and the last three months. we can do a lot to improve teamwork in hospitals and a lot of it starts with the peer respected leaders. >> host: the work that she did really talk about the issues of culture, the importance of teamwork. i am struck with the many examples that you've given and her three years of the importance of the members of the team, perhaps not the surgeon speaking up in effect you describe one in your book. what has to happen for you to become more common in the culture, it actually besieger areas or perhaps we equate the operating room to what happens flying a plane and the need for aviation went through some of these things decades ago and
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that they took away. from your good, how does the teamwork and enhanced moving forward from what starts at? who has to start at? >> guest: is one of those cultural traits that changes over time, but we need to change it. we look at the hierarchy of medicine and hierarchy of the military. we have rules and procedures, ways of doing things. we have unwritten standards that we never go by their superiors had for anything. i think we can be more honest and open about the problems in health care and redesigned the way we talk in the operating room in the health care setting and clinics in the hospital. when we developed a checklist for the operating room, this is after peter provost has worked in the icu and said we're going to have a daily goal sheet.
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and go on the vitter popularized , the world health organization group. it became much bigger than we ever anticipated. the number one priority that we made in the checklist was making the first item, going over the names and numbers of the team, going over their roles. deshaies a simple introduction. when gore won the land, he was particular that be the number one item as well. we have setup a value in making introductions, just a simple statement of your name and what role you have in the team to be a critical part not only to be friendly. let's face it that's nice, but that wasn't the goal. it was to empower people to speak out. at your workplace to have a conference room and you're sitting around for a meeting and
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you have to say something in the beginning our present some pain. it's easier to speak up again. it's almost as if the first time he speak up and say anything, your act debated and that's what we try to do is activate every member of the team. >> host: settee members are activated. what about the patient? >> guest: absolutely. it's amazing the amount of information patient family members added to our understanding of the patient's condition. by and large, a featuring a family member when they see their doctor, go with them. this new program called open nose allows patients to instantly see their doctors note when they see a doctor for a visit has been tremendously successful, not because it's going to fix health care. let's face it. innovation like that is not going to solve our health care
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crisis. but there's this disproportionate amount of enthusiasm for it because what it represents. it represents the profession of bridging the divide and senior part of this for doctors sharing with the patient in an open and honest way. what you see what our plan is. i want you to see what i wrote down. even at a line to it if you like. say at the bottom i agree or there's a mistake or a misspoke. i don't think this represents me and that will be part of the patient's record. one time i had a patient asking about abdominal pain and she asked me a question i was a little bizarre. something about a certain type of ben & jerry's ice cream over another type caused this kind of pain. i told her no it doesn't. it's unrelated. and then she at the end have the suspicion and it turns out she was worried that i wrote in the
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chart that she's a psycho or crazy or some thing. i said no, here it is. when she saw the know, the bond of trust is almost totally restored. >> host: we have a couple minutes left. first of all, it's the role of readers and clinicians. what rules to boards of trustees of hospitals in particular -- another spinning the hint around getting them involved. wonder if you can spend a minute talking about that. >> guest: i was disappointed i saw that apart and at hhs in their attempt to make one physician, at least i want position on the board of a hospital and they overturn this intended rule at the last minute and it was a great disappointment to a lot of doctors. ..

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